Line 14 Offer of Coverage and Line 16 Safe Harbor Code Derivation Logic

Line 14–Offer of Coverage Codes

The system will evaluate each code below in the order listed starting with 1A for each employee for each month. If the employee meets the conditions for an Offer of Coverage Code, that value will be returned and inserted into the ACA data for that employee for that month. If the conditions are not met, the next Offer of Coverage Code will be evaluated. This will continue until the employee meets the conditions for one of the Offer Codes.

Line 14 Code IRS Definition
1A Qualifying Offer: Minimum essential coverage providing minimum value offered to full-time employee with Employee Required Contribution equal to or less than 9.5% (as adjusted) of mainland single federal poverty line and at least minimum essential coverage offered to spouse and dependent(s)
1B Minimum essential coverage providing minimum value offered to employee only.
1C Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) (not spouse).
1D Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to spouse (not dependent(s)). Do not use code 1D if the coverage for the spouse was offered conditionally. Instead, use code 1J
1E Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage offered to dependent(s) and spouse. Do not use code 1E if the coverage for the spouse was offered conditionally. Instead, use code 1K
1F Minimum essential coverage NOT providing minimum value offered to employee; employee and spouse or dependent(s); or employee, spouse, and dependents.
1G Offer of coverage for at least one month of the calendar year to an individual who was not an employee for any month of the calendar year or to an employee who was not a full-time employee for any month of the calendar year (which may include one or more months in which the individual was not an employee) and who enrolled in self-insured coverage for one or more months of the calendar year. Note. Code 1G applies for the entire year or not at all. Therefore, if code 1G applies, an ALE Member must enter code 1G on line 14 in the “All 12 Months” column or in each separate monthly box (for all 12 months)
1H No offer of coverage (employee not offered any health coverage or employee offered coverage that is not minimum essential coverage, which may include one or more months in which the individual was not an employee)
1I Reserved.
1J Minimum essential coverage providing minimum value offered to employee and at least minimum essential coverage conditionally offered to spouse; minimum essential coverage not offered to dependent(s).
1K 1K. Minimum essential coverage providing minimum value offered to employee; at least minimum essential coverage offered to dependents; and at least minimum essential coverage conditionally offered to spouse.
1L Individual coverage HRA offered to employee only with affordability determined by using employee’s primary residence location ZIP code.
1M Individual coverage HRA offered to employee and dependent(s) (not spouse) with affordability determined by using employee’s primary residence location ZIP code.
1N Individual coverage HRA offered to employee, spouse, and dependent(s) with affordability determined by using employee’s primary residence location ZIP code.
1O Individual coverage HRA offered to employees only using the employee’s primary employment site ZIP code affordability safe harbor.
1P Individual coverage HRA offered to employee and dependent(s) (not spouse) using the employee’s primary employment site ZIP code affordability safe harbor.
1Q Individual coverage HRA offered to employee, spouse, and dependent(s) using employee’s primary employment site ZIP code affordability safe harbor.
1R Individual coverage HRA that is NOT affordable offered to employee; employee and spouse, or dependent(s); or employee, spouse and dependents.
1S Individual coverage HRA offered to an individual who was
not a full-time employee.
1T - 1Z Reserved.

 

Line 14 Code Derivation Logic
1A
  • Minimum Essential Coverage and Minimum Value Coverage are true.
  • Offer of coverage is true for Employee, Spouse, and Children.
  • Employee status is not terminated, and Employee is not a mid-month hire.
  • Employee only monthly premium is equal to or less than the mainland federal poverty line.
1E
  • Minimum Essential Coverage and Minimum Value Coverage are true.
  • Offer of coverage is true for Employee, Spouse, and Children.
  • Employee status is not terminated, and Employee is not a mid-month hire.
  • Employee only monthly premium is greater than the mainland federal poverty line.
1F
  • Minimum Essential Coverage is True.
  • Minimum Value is False.
  • Offer of coverage is true for Employee.
  • Employee status is not terminated, and Employee is not a mid-month hire.
1B
  • Minimum Essential Coverage and Minimum Value Coverage are true.
  • Offer of coverage is true for Employee.
  • Offer of coverage is false for Spouse and Children.
  • Employee status is not terminated, and Employee is not a mid-month hire.
1C
  • Minimum Essential Coverage and Minimum Value Coverage are true.
  • Offer of coverage is true for Employee and Spouse.
  • Offer of coverage is false for Spouse.
  • Employee status is not terminated, and Employee is not a mid-month hire.
1D
  • Minimum Essential Coverage and Minimum Value Coverage are true.
  • Offer of coverage is true for Employee and Spouse.
  • Offer of coverage is false for Children.
  • Employee status is not terminated, and Employee is not a mid-month hire.
1G
  • Client Provided Code
1J
  • Client Provided Code
1K
  • Client Provided Code
1I
  • *Reserved*
1H
  • Coverage offered is false *OR*
  • Minimum Essential Coverage is false *OR*
  • Individual is not employed and employment status is not retired *OR*
  • Mid-month hire is true

Line 16 - Safe Harbor Codes

The system will evaluate each code below in the order listed starting with 2A for each employee for each month. If the employee meets the conditions for an Safe Harbor Code, that value will be returned and inserted into the ACA data for that employee for that month. If the conditions are not met, the next Safe Harbor Code will be evaluated. This will continue until the employee meets the conditions for one of the Safe Harbor Codes

Line 16 Code IRS Definition
2A Employee not employed during the month. Enter code 2A if the employee was not employed on any day of the calendar month. Do not use code 2A for a month if the individual was an employee of the ALE Member on any day of the calendar month. Do not use code 2A for the month during which an employee terminates employment with the ALE Member.
2B Employee not a full-time employee. Enter code 2B if the employee is not a full-time employee for the month and did not enroll in minimum essential coverage, if offered for the month. Enter code 2B also if the employee is a full-time employee for the month and whose offer of coverage (or coverage if the employee was enrolled) ended before the last day of the month solely because the employee terminated employment during the month (so that the offer of coverage or coverage would have continued if the employee had not terminated employment during the month).
2C Employee enrolled in health coverage offered. Enter code 2C for any month in which the employee enrolled for each day of the month in health coverage offered by the ALE Member, regardless of whether any other code in Code Series 2 might also apply (for example, the code for a section 4980H affordability safe harbor) except as provided below. Do not enter code 2C on line 16 for any month in which the multiemployer interim rule relief applies (enter code 2E). Do not enter code 2C on line 16 if code 1G is entered on line 14. Do not enter code 2C on line 16 for any month in which a terminated employee is enrolled in COBRA continuation coverage or other post-employment coverage (enter code 2A). Do not enter code 2C on line 16 for any month in which the employee enrolled in coverage that was not minimum essential coverage.
2D Employee in a section 4980H(b) Limited Non-Assessment Period. Enter code 2D for any month during which an employee is in a section 4980H(b) Limited Non-Assessment Period. If an employee is in an initial measurement period, enter code 2D (employee in a section 4980H(b) Limited NonAssessment Period) for the month, and not code 2B (employee not a full-time employee). For an employee in a section 4980H(b) Limited Non-Assessment Period for whom the ALE Member is also eligible for the multiemployer interim rule relief for the month, enter code 2E (multiemployer interim rule relief) and not code 2D (employee in a section 4980H(b) Limited Non-Assessment Period).
2E Multiemployer interim rule relief. Enter code 2E for any month for which the multiemployer arrangement interim guidance applies for that employee, regardless of whether any other code in Code Series 2 (including code 2C) might also apply.
2F Section 4980H affordability Form W-2 safe harbor. Enter code 2F if the ALE Member used the section 4980H Form W-2 safe harbor to determine affordability for purposes of section 4980H(b) for this employee for the year. If an ALE Member uses this safe harbor for an employee, it must be used for all months of the calendar year for which the employee is offered health coverage.
2G Section 4980H affordability federal poverty line safe harbor. Enter code 2G if the ALE Member used the section 4980H federal poverty line safe harbor to determine affordability for purposes of section 4980H(b) for this employee for any month(s).
2H Section 4980H affordability rate of pay safe harbor. Enter code 2H if the ALE Member used the section 4980H rate of pay safe harbor to determine affordability for purposes of section 4980H(b) for this employee for any month(s).
2I Reserved

 

Line 16 Code Derivation Logic
2C
  • Employee was covered every day of the month.
  • Employee status is not terminated.
  • Coverage Waived is false
2A
  • Individual is not an employee any day of the month.
  • Individual was not terminated mid-month.
2B
  • Employment status is not Full Time
2E
  • Client Provided – (Multi-Employer Relief)
2D
  • Employee is in an initial measurement period *OR*
  • Employee is in a waiting period with a future coverage effective date.
2I
  • *Reserved*
2F
  • Safe Harbor is W2
2G
  • Safe Harbor is Federal Poverty Line
2H
  • Safe Harbor is Rate of Pay
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